Gene Expression Profiling for Melanoma

In this interview with The Dermatologist, Dr Abigail Waldman discusses her session, "Managing Melanoma Risk and Prognosis by Gene Expression Profiling and Nodal Staging," at the 2023 ACMS Annual Meeting.

Abigail H Waldman, MD, FACMS, is an assistant professor at Harvard Medical School and the director of Mohs surgery at Brigham and Women’s Hospital in Boston, MA.

The Dermatologist: Can you give us a preview of what will be covered during your session at the 2023 ACMS Annual Meeting?

Dr Waldman: Our session is going to evaluate the use of gene expression profiling to categorize low- and high-risk melanomas, as well as any change in the guidance of sentinel lymph node biopsies for low- and high-risk melanoma.

The Dermatologist: How would you categorize high-risk melanomas using gene expression profiling?

Dr Waldman: Gene expression profiling, at least the 31-CEP, categorizes melanomas into low risk, medium risk, and high risk. The low risk is a melanoma that has a less than 5% chance of having a positive nodal metastasis. A medium risk is anywhere from 5% to 10% risk. The high-risk category is those who are predicted to have a greater than 10% risk of nodal metastasis.

The Dermatologist: What key points do you hope attendees take away from your session?

Dr Waldman: I hope that people realize when to use the 31-GEP or any other gene expression profiling. There have not been prospective studies to validate the findings. This is still in its infancy. People are using it more and more. Oncologists are using it. Dermatologists are using it. However, it's not at the point where it's going to be strongly recommended. However, there's more research to come. I do anticipate this is a field that's going to grow and that you're going to need to stay on top of the current findings to know how to take care of your patients in the best way.

The Dermatologist: What additional tips and insights would you like to share with your colleagues regarding gene expression profiling for melanoma?

Dr Waldman: I would say the tips from this talk should be that for a low risk, like a T1a melanoma patient, the use of this is not great for using the 31-GEP. Meaning, that this is a patient who you shouldn't necessarily use it in. Where it can be useful is in a patient with intermediate risk where if the 31-GEP shows a low-risk tumor, that might help the patient decide, if they're already on the fence about whether to do it, that you might be able to provide some reassurance to not proceed with the sentinel lymph node biopsy.

Then, I think as more perspective studies come out, it might even help guide the higher-risk stage 2A and 2C patients who might be considering using adjuvant immunotherapy. Right now, it hasn't been validated in that manner. But I think research is coming along the pipeline that might help us decide which of those high-risk stage 2B and 2C patients will most benefit from immunotherapy.

Reference
Waldman AH. Managing melanoma risk and prognosis by gene expression profiling and nodal staging. Presented at: American College of Mohs Surgery (ACMS) Annual Meeting; May 4–7, 2023; Seattle, WA.

Watch Dr Waldman's interview video!